Effect of average volume-assured pressure support treatment on health-related quality of life in COPD patients with chronic hypercapnic respiratory failure: a randomized trial

Doaa M Magdy, Ahmed Metwally, Doaa M Magdy, Ahmed Metwally

Abstract

The long-term effect of average volume-assured pressure support (AVAPS) on health-related quality of life (HRQOL) in chronic obstructive pulmonary disease (COPD) patients with chronic hypercapnic respiratory failure (CHRF) remains unclear. The objective of this study is to identify the long-term effect of AVAPS in COPD patients with CHRF through assessment of HRQOL, exercise tolerance after six months duration.

Methods: In this randomized, controlled, parallel-group study, 40 stable hypercapnic COPD patients were randomized in a 1:1 ratio to receive either spontaneous timed AVAPS (ST/AVAPS) (intervention) or Bilevel positive airway pressure (ST/BiPAP) (control). HRQL was measured with the Short Form 12 Health Survey Questionnaire (SF-12). Exercise tolerance assessed by 6 min walking distance. Analyses were done between groups from baseline to the average of six months measurements.

Results: AVAPS led to significant 6 months improvements in several domains of (SF-12) compared to the control group, with the greatest improvement seen in general health [treatment effect of 8.2 points (95% confidence interval [95% CI 3.2 to 11.7; p = 0.001)], vitality (treatment effect 5.4 points [95% CI 1.4 to 9.3]; p = 0.001), physical functioning 5.5 points [95% CI 1.1 to 9.8]; p = 0.001) and bodily pain 5.1 points [95% CI 3.4 to 8.8]; p = 0.002). The physical health summary score improved by 3.7 points (95% CI 1.2 to 5.8; p = 0.001), but no significant improvement in the emotional or social role functioning, mental health subscale was noted. AVAPS also resulted in improvement 6 min walking distance 9.2 points (95% CI - 1 to - 15];p = 0.001). A significant reduction in the daytime (PaCO2) was observed after 6 months in those treated with AVAPS.

Conclusions: In COPD patients with hypercapnic respiratory failure, AVAPS improved exercise tolerance and multiple domains of HRQOL over six months of follow-up, with the significant improvement observed in general health.

Keywords: Chronic obstructive/epidemiology; Health status; Pulmonary disease; Quality of life.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart diagram

References

    1. Global Initiative for Chronic Obstructive Lung Disease . Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. 2018.
    1. Laghi F, Tobin MJ. Disorders of the respiratory muscles. Am J Respir Crit Care Med. 2003;168:10–43. doi: 10.1164/rccm.2206020.
    1. Crockett AJ, Cranston JM, Moss JR, Alpers JH. A review of long-term oxygen therapy for chronic obstructive pulmonary disease. Respir Med. 2001;95(6):437–443. doi: 10.1053/rmed.2001.1064.
    1. Murphy PB, Davidson C, Hind MD, et al. Volume targeted versus pressure support non-invasive ventilation in patients with super obesity and chronic respiratory failure: a randomised control ed. Thorax. 2012;67:727–734. doi: 10.1136/thoraxjnl-2011-201081.
    1. Kelly JL, Jaye J, Pickersgill RE, Chatwin M, Morrell MJ, Simonds AK. Randomized trial of ‘intelligent’ auto-titrating ventilation versus standard pressure support non-invasive ventilation: impact on adherence and physiological outcomes. Respirology. 2014;19(4):596–603. doi: 10.1111/resp.12269.
    1. Crisafulli E, Manni G, Kidonias M, Trianni L, Clini EM. Subjective sleep quality during average volume assured pressure support (AVAPS) ventilation in patients with hypercapnic COPD: a physiological pilot study. Lung. 2009;187(5):299–305. doi: 10.1007/s00408-009-9167-1.
    1. Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319–338. doi: 10.1183/09031936.05.00034805.
    1. Bestall JC, Paul EA, Garrod R, et al. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999;54:581–586. doi: 10.1136/thx.54.7.581.
    1. American Thoracic Society/European Respiratory Society ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002;166:518–624. doi: 10.1164/rccm.166.4.518[doi].
    1. Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE, et al. Cross-validation of item selection and scoring for the SF-12 health survey in nine countries: results from the IQOLA project. International quality of life assessment. J Clin Epidemiol. 1998;51:1171–1178. doi: 10.1016/S0895-4356(98)00109-7.
    1. Almagro P, Calbo E, Ochoa de Echaguen A, Barreiro B, Quintana S, Heredia JL, et al. Mortality after hospitalization for COPD. Chest. 2002;121:1441–1448. doi: 10.1378/chest.121.5.1441.
    1. Nilius G, Katamadze N, Domanski U, Schroeder M, Franke KJ. Non-invasive ventilation with intelligent volume-assured pressure support versus pressure-controlled ventilation: effects on the respiratory event rate and sleep quality in COPD with chronic hypercapnia. Int J Chron Obstruct Pulmon Dis. 2017;12:1039–1045. doi: 10.2147/COPD.S126970.
    1. Oscroft NS, Chadwick R, Davies MG, Quinnell TG, Smith IE. Volume assured versus pressure preset non-invasive ventilation for compensated ventilatory failure in COPD. Respir Med. 2014;108:1508–1515. doi: 10.1016/j.rmed.2014.07.010.
    1. Ekkernkamp E, Storre JH, Windisch W, Dreher M. Impact of intelligent volume-assured pressure support on sleep quality in stable hypercapnic chronic obstructive pulmonary disease patients: a randomized, crossover study. Respiration. 2014;88:270–276. doi: 10.1159/000364946.
    1. Orr Jeremy E., Coleman John, Criner Gerard J., Sundar Krishna M., Tsai Sheila C., Benjafield Adam V., Crocker Maureen E., Willes Leslee, Malhotra Atul, Owens Robert L., Wolfe Lisa F. Automatic EPAP intelligent volume‐assured pressure support is effective in patients with chronic respiratory failure: A randomized trial. Respirology. 2019;24(12):1204–1211. doi: 10.1111/resp.13546.
    1. Borel Jean-Christian, Pepin Jean-Louis, Pison Christophe, Vesin Aurélien, Gonzalez-Bermejo Jesus, Court-Fortune Isabelle, Timsit Jean-François. Long-term adherence with non-invasive ventilation improves prognosis in obese COPD patients. Respirology. 2014;19(6):857–865. doi: 10.1111/resp.12327.
    1. Limsuwat C, Rawangnam W, Ruangsomboon O, Prapruetkit N. Effect of non-invasive mechanical ventilation with average volume assured pressure support (AVAPS) in patients with chronic obstructive pulmonary disease with acute exacerbation: a randomized pilot trial. Southwest Respir Crit Care Chronicles. 2019;7(30):19–28. doi: 10.12746/swrccc.v7i30.560.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel